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. 2022 Nov 30;19(23):16047.
doi: 10.3390/ijerph192316047.

Tegumentary Leishmaniasis in Northeastern Italy from 2017 to 2020: A Neglected Public Health Issue

Valeria Gaspari  1 , Tommaso Gritti  2 , Margherita Ortalli  2 , Annalisa Santi  3 , Giorgio Galletti  3 , Arianna Rossi  3 , Gianluca Rugna  3 , Andrea Mattivi  4 , Giulio Matteo  4 , Gian L Belloli  4 , Giovanna Mattei  4 , Stefania Varani  2   5 , On Behalf Of The Skin Leish Rer Network
Affiliations

Tegumentary Leishmaniasis in Northeastern Italy from 2017 to 2020: A Neglected Public Health Issue

Valeria Gaspari et al. Int J Environ Res Public Health. .

Abstract

Tegumentary leishmaniasis (TL) includes cutaneous (CL) and mucosal (ML) leishmaniasis; despite being endemic in southern Europe, it is often underdiagnosed and underreported. This study aimed to retrospectively examine data collected from patients with TL in a selected area of northeastern Italy (Emilia-Romagna region, RER). A network of 10 diagnostic units within RER was established, and TL cases diagnosed in RER from 2017 to 2020 were evaluated. A total of 135 TL cases were collected (62% male, 38% female); patients ranged from 1 to 84 years, with a median age of 57. Among these cases, 113 (84%) were notified to the public health authorities. The average annual incidence of TL was 0.76 cases per 100,000 inhabitants. Infections were acquired within the RER in 84% of cases; the 113 autochthonous cases were distributed in the foothills areas of the region. We provide evidence of a defined spatial distribution of TL cases in a selected area of northeastern Italy, as well as a relevant number of ML cases. Our observations suggest the need to raise awareness about TL among clinicians and pathologists, promote the molecular confirmation of cases by reference laboratories, and encourage the establishment of surveillance networks for this neglected disease.

Keywords: Leishmania infantum; autochthonous cases; cutaneous leishmaniasis; mucosal leishmaniasis; tegumentary leishmaniasis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Geographic distribution of autochthonous cases of tegumentary leishmaniasis (n = 113), Emilia-Romagna region, northeastern Italy, 2017–2020.
Figure 2
Figure 2
Age and sex distribution of cases of cutaneous (CL, a) and mucosal (ML, b) leishmaniasis (n = 135), Emilia-Romagna region (northeastern Italy), 2017–2020.
Figure 3
Figure 3
Incidence of tegumentary leishmaniasis by sex and year (a) and by age (b), Emilia-Romagna region (northeastern Italy), 2017–2020. CL, cutaneous leishmaniasis; ML, mucosal leishmaniasis.
Figure 4
Figure 4
Clinical characteristics of tegumentary leishmaniasis cases in the Emilia-Romagna region, northeastern Italy, 2017–2020. (a) Frequency of lesions in different anatomic sites in males and females. Data were available for 124 cases of cutaneous leishmaniasis (CL) and 10 cases of mucosal leishmaniasis (ML); (b) frequency of different types of lesions. Data were available for 90 CL cases and 8 ML cases.
Figure 5
Figure 5
Comparative features of tegumentary leishmaniasis by patients’ immune status (n = 102). Severe and mild TL were defined in the Material and Method section. ND; not defined.
Figure 6
Figure 6
Histological diagnosis of tegumentary leishmaniasis: haematoxylin-eosin and Giemsa staining. (a,b): Hematoxylin-eosin (HE) staining reveals many amastigotes that appear as blue-greyish round structures, mostly contained in macrophages (black arrows), and that are associated with a dense inflammatory infiltrate and granulomatous areas. An abundance of amastigotes can be easily appreciated at low power view. (a): 100× magnification, (b): 600× magnification. (c,d): When the amastigotes are scarce, or the inflammatory infiltrate is particularly intense, the diagnosis of leishmaniasis can be overlooked by employing HE staining (c, 400× magnification); in these cases, Giemsa staining (d) can contribute to revealing the amastigotes (black arrows, 400× magnification).
Figure 7
Figure 7
Therapeutic approaches for tegumentary leishmaniasis in the Emilia-Romagna region, northeastern Italy, 2017–2020.
See this image and copyright information in PMC

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